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A literature review on the analysis of symptom-based clinical pathways: Time for a different approach?
Breathlessness is a common clinical presentation, accounting for a quarter of all emergency hospital attendances. As a complex undifferentiated symptom, it may be caused by dysfunction in multiple body systems. Electronic health records are rich with activity data to inform clinical pathways from un...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9931260/ https://www.ncbi.nlm.nih.gov/pubmed/36812546 http://dx.doi.org/10.1371/journal.pdig.0000042 |
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author | Gunatilleke, Nammunikankanange Janak Fleuriot, Jacques Anand, Atul |
author_facet | Gunatilleke, Nammunikankanange Janak Fleuriot, Jacques Anand, Atul |
author_sort | Gunatilleke, Nammunikankanange Janak |
collection | PubMed |
description | Breathlessness is a common clinical presentation, accounting for a quarter of all emergency hospital attendances. As a complex undifferentiated symptom, it may be caused by dysfunction in multiple body systems. Electronic health records are rich with activity data to inform clinical pathways from undifferentiated breathlessness to specific disease diagnoses. These data may be amenable to process mining, a computational technique that uses event logs to identify common patterns of activity. We reviewed use of process mining and related techniques to understand clinical pathways for patients with breathlessness. We searched the literature from two perspectives: studies of clinical pathways for breathlessness as a symptom, and those focussed on pathways for respiratory and cardiovascular diseases that are commonly associated with breathlessness. The primary search included PubMed, IEEE Xplore and ACM Digital Library. We included studies if breathlessness or a relevant disease was present in combination with a process mining concept. We excluded non-English publications, and those focussed on biomarkers, investigations, prognosis, or disease progression rather than symptoms. Eligible articles were screened before full-text review. Of 1,400 identified studies, 1,332 studies were excluded through screening and removal of duplicates. Following full-text review of 68 studies, 13 were included in qualitative synthesis, of which two (15%) were symptom and 11 (85%) disease focused. While studies reported highly varied methodologies, only one included true process mining, using multiple techniques to explore Emergency Department clinical pathways. Most included studies trained and internally validated within single-centre datasets, limiting evidence for wider generalisability. Our review has highlighted a lack of clinical pathway analyses for breathlessness as a symptom, compared to disease-focussed approaches. Process mining has potential application in this area, but has been under-utilised in part due to data interoperability challenges. There is an unmet research need for larger, prospective multicentre studies of patient pathways following presentation with undifferentiated breathlessness. |
format | Online Article Text |
id | pubmed-9931260 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-99312602023-02-16 A literature review on the analysis of symptom-based clinical pathways: Time for a different approach? Gunatilleke, Nammunikankanange Janak Fleuriot, Jacques Anand, Atul PLOS Digit Health Research Article Breathlessness is a common clinical presentation, accounting for a quarter of all emergency hospital attendances. As a complex undifferentiated symptom, it may be caused by dysfunction in multiple body systems. Electronic health records are rich with activity data to inform clinical pathways from undifferentiated breathlessness to specific disease diagnoses. These data may be amenable to process mining, a computational technique that uses event logs to identify common patterns of activity. We reviewed use of process mining and related techniques to understand clinical pathways for patients with breathlessness. We searched the literature from two perspectives: studies of clinical pathways for breathlessness as a symptom, and those focussed on pathways for respiratory and cardiovascular diseases that are commonly associated with breathlessness. The primary search included PubMed, IEEE Xplore and ACM Digital Library. We included studies if breathlessness or a relevant disease was present in combination with a process mining concept. We excluded non-English publications, and those focussed on biomarkers, investigations, prognosis, or disease progression rather than symptoms. Eligible articles were screened before full-text review. Of 1,400 identified studies, 1,332 studies were excluded through screening and removal of duplicates. Following full-text review of 68 studies, 13 were included in qualitative synthesis, of which two (15%) were symptom and 11 (85%) disease focused. While studies reported highly varied methodologies, only one included true process mining, using multiple techniques to explore Emergency Department clinical pathways. Most included studies trained and internally validated within single-centre datasets, limiting evidence for wider generalisability. Our review has highlighted a lack of clinical pathway analyses for breathlessness as a symptom, compared to disease-focussed approaches. Process mining has potential application in this area, but has been under-utilised in part due to data interoperability challenges. There is an unmet research need for larger, prospective multicentre studies of patient pathways following presentation with undifferentiated breathlessness. Public Library of Science 2022-05-26 /pmc/articles/PMC9931260/ /pubmed/36812546 http://dx.doi.org/10.1371/journal.pdig.0000042 Text en © 2022 Gunatilleke et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Gunatilleke, Nammunikankanange Janak Fleuriot, Jacques Anand, Atul A literature review on the analysis of symptom-based clinical pathways: Time for a different approach? |
title | A literature review on the analysis of symptom-based clinical pathways: Time for a different approach? |
title_full | A literature review on the analysis of symptom-based clinical pathways: Time for a different approach? |
title_fullStr | A literature review on the analysis of symptom-based clinical pathways: Time for a different approach? |
title_full_unstemmed | A literature review on the analysis of symptom-based clinical pathways: Time for a different approach? |
title_short | A literature review on the analysis of symptom-based clinical pathways: Time for a different approach? |
title_sort | literature review on the analysis of symptom-based clinical pathways: time for a different approach? |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9931260/ https://www.ncbi.nlm.nih.gov/pubmed/36812546 http://dx.doi.org/10.1371/journal.pdig.0000042 |
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